The overarching goal of the project is the improvement of services for individuals with co-occurring disorders from rural areas enrolling in substance abuse treatment. In order to accomplish this goal, three specific aims will be accomplished. The first specific aim is the training for assessment of co-occurring disorders. This aim will be accomplished by training throughout programs in two rural areas and one small urban community by expert trainers from Duke University and the Co-occurring Center for Excellence established by CSAT at NDRI. The second specific aim will be the testing and implementation of a telemedicine model of a screening form for co-occurring disorders. This model will use the standard Mental Health Screening Assessment administered by a trained clinician at the central program site using an interactive computer interview. The third aim will be the comparison of the telemedicine model with the standard screening procedure used in programs. A randomly selected group of admissions to each program will be assigned to each approach. The primary outcome will be follow-through on the initial appointment for mental health services with the program psychiatrist. Secondary outcomes will be the retention in treatment and attendance at the meetings with the psychiatrist. The number of co-occurring cases identified through the screens, the specificity of the assessment compared to psychiatrist diagnosis will also be examined. The costs of each approach, primarily the time of the psychiatrist will be calculated. This project will serve as an important step in providing more and better services to the rural populations served by the Coastal Horizons programs through the use of telemedicine approaches. Should this initial phase prove successful, the approach could be expanded to intake assessment, treatment planning and actual counseling and other services. [unreadable] [unreadable] [unreadable]